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Showing results for tags 'Emergency medicine'.
Found 373 results
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Content ArticlePatients are vulnerable during emergency episodes outside the formal care sector, for example, care provided by paramedics responding to a stroke or heart attack at home. Yet much less is known about the safety of Emergency Medical Services (EMS) as compared with primary or secondary healthcare. This relative lack of information is important given there are aspects of EMS care that create unique patient safety challenges. This BMJ Editorial discusses how we can improve patient safety in the Emergency Medical Services.
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Content ArticleNHS services have been under increasing pressure in recent years, particularly since the start of the Covid-19 pandemic. We have previously reported on the NHS’s efforts to tackle the backlogs in elective care and its progress with improving mental health services in England. This report gives an overview of NHS services that may be used when people need rapid access to urgent, emergency or other non-routine health services, and whether such services are meeting the performance standards the NHS has told patients they have a right to expect. It covers: general practice community pharmacy 111 calls ambulance services (including 999 calls) urgent treatment centres accident and emergency (A&E) departments.
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Content ArticleCommunity public access defibrillators (CPADs) contain an automated electronic device (AED) that, in the event of a sudden out of hospital cardiac arrest, can provide lifesaving treatment by delivering an electric shock to the heart. CPADs can be found in public areas such as disused telephone boxes or community centres, and often the defibrillators are locked and a special code is needed to open the unit. In this blog, Sharon Perkins, HSIB Maternity Investigator, looks at the issues surrounding the accessibility of CPADs. During the course of a maternity investigation, the HSIB team became aware of instances where access to CPADs had been restricted by their location and lack of registration.
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Content ArticleIn this article in the New Yorker, Lucy Easthope, who has worked on major emergencies since 9/11, says that small interventions can make a significant difference.
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Content ArticleOn the 9 October 2021 an investigation was carried out into the death of Ms Sandra Diane Finch, a 44 year old woman who had a history of Type 1 diabetes mellitus. The investigation concluded at the end of the inquest on 3 May 2023. The conclusion of the inquest was a narrative conclusion of ketoacidosis due to insulin depravation contributed to by neglect. The cause of death was: 1a) Ketoacidosis 1b) Uncontrolled Type 1 Diabetes Mellitus 1c) Insulin depravation.
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Content ArticleEuropean guidelines advise that patients suffering ST-segment elevation myocardial infarction (STEMI) should be revascularised within 120 minutes of diagnosis. The preferred method of revascularization is primary percutaneous coronary intervention (pPCI). This study in BMJ Heart analysed the Northern Irish STEMI database to establish the proportion of pPCI delivered within the recommended treatment window. It aimed to determine whether there was any difference in long-term survival for patients treated beyond the recommended time window. The authors found that delays that result in primary PCI beyond 120 minutes from diagnostic ECG are associated with a significantly increased risk of mortality following STEMI in Northern Ireland.
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Content Article
NHS Impact resources
Patient Safety Learning posted an article in NHS England
NHS Impact ‘improving patient care together’ is the term NHS England is using for the new single, shared NHS improvement approach. This includes the five components which form the ‘DNA’ of all evidence-based improvement methods, which underpin a systematic approach to continuous improvement: Building a shared purpose and vision. Investing in people and culture. Developing leadership behaviours. Building improvement capability and capacity. Embedding improvement into management systems and processes. When these 5 components are consistently used, systems and organisations create the right conditions for continuous improvement and high performance, responding to today’s challenges, and delivering better care for patients and better outcomes for communities. -
Content ArticleThis is the first national ambulance volunteering strategy, produced by the Association of Ambulance Chief Executives. It recognises the important role volunteers play in the ambulance service and outlines a national approach to volunteering that will be adopted between January 2023 and May 2024. The strategy covers mission, vision, principles and measures of success.
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Content ArticleIn this presentation from the AD Awareness Day UK 2018, Dr Emma Redfern and Prof Mark Callaway provide a Masterclass in diagnosing aortic dissection in the emergency setting.
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Content ArticleThis case study published by The Beryl Institute looks at an initiative to collect real-time feedback on patient experiences at the Stanford Health Care emergency department in California. Previously, the department had sent a survey to patients well after their visit, but the team realised that capturing this information sooner was critical. Matthew Lim, Patient Experience Manager at Stanford Health Care describes the practical and replicable steps the organisation took in implementing a QR code-based feedback system. He describes the results, lessons learned and potential future developments.
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Content ArticleThis white paper from CEMBooks aims to unpick some of the deeper issues surrounding bed block and emergency department crowding from the perspective of a frontline medic with two decades of emergency and flow management experience. It aims to provide a greater understanding of the factors influencing the current situation and the measures used to define it followed by some practical implementable solutions.
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Content ArticleThe results from the 2022 British Social Attitudes survey made for very difficult reading for those of us working in the NHS right now. Overall satisfaction with the NHS is at the lowest level ever recorded and similarly satisfaction with individual services is at record lows across the board, but it was satisfaction with A&E services that saw the sharpest fall in 2022. Kelly Ameneshoa, an Emergency Medicine Doctor working across South London and Surrey, reflects on the findings.
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News Article
Majority of ‘last resort’ ambulance diverts reported by only two trusts
Patient Safety Learning posted a news article in News
Two acute trusts account for almost two-thirds of emergency department ‘diverts’ reported over the last two months. Between the start of December and the start of February, Worcestershire Acute Hospitals Trust and University Hospitals Sussex Foundation Trust implemented 122 temporary “diverts” between them – representing around 60% of the national total. The measure is taken when a particular site, such as Worcestershire Royal or Royal Sussex County Hospital, comes under significant pressure and ambulances are temporarily directed to an alternative hospital, usually within the same trust. NHS England guidance says diverts of emergency patients due to lack of physical or staff capacity to deal with attendances or admissions “should be an action of last resort” and that this “should only need to happen in exceptional circumstances, where internal measures have not succeeded in tackling the underlying problem”. Helen Hughes, chief executive of Patient Safety Learning, said: “For ambulance services, the impact of A&E diverts is two-fold. It both increases the length of journeys that crews have to make once a divert is implemented, and increases the travel time required to get back to subsequent emergency calls." “This has the potential to increase waiting times for patients, increasing the risk of avoidable harm, particularly for those who are seriously ill, frail or elderly.” Read full story (paywalled) Source: HSJ, 15 February 2022 -
News ArticleRegistered nurses (RNs) at US Prime Healthcare’s West Anaheim Medical Center (WAMC) will hold an informational picket today to protest chronic short staffing and its impact on safe patient care. Nurses say that the hospital should cancel elective surgeries because those beds and nurses are needed for other emergent patients. RNs in all medical departments are short-staffed, putting patient safety in jeopardy. “Nurses are under incredible pressure to care for patients beyond the state’s mandated safe staffing ratios due to the staffing crisis in our hospital,” said John Olarte, RN at WAMC. “The employer should be making beds available by canceling elective surgeries for the foreseeable future. Save those beds for the patients who most need them and at the same time give the RNs a chance to truly care for these patients by not forcing nurses to take patients that don’t need to be in the hospital right now. The public needs to know that the hospital is not doing everything they can to help the nurses care for patients.” “There is a staffing crisis because RNs are leaving,” said Sofia Rivera, RN in the emergency department at WAMC, “To attract and retain quality nurses — just staff the floors so the RNs do not have to pick up multiple extra shifts due to the revolving door of RNs in this hospital.” Nurses say they want a strong contract so they can recruit and retain RNs and they want to establish a health and safety committee to ensure they have a voice on issues of nurse safety and patient care. They have been in contract negotiations since May 2021. Their contract expired in June 2021. “We are getting slaughtered in the ER,” said Rasha Tran, RN. “Ambulances are just leaving their patients in the ER instead of waiting for an available bed because they are waiting too long. I don’t even know how we can sustain this demand to care for so many patients. It means less care for each patient. Continuing elective surgeries means that a regular bed is not available for a patient in the ER who is now is being held for hours or days before they are admitted. Even before this most recent Covid surge, nurses have been picking up extra 12-hour shifts to help our coworkers, often without a break for meals or rest periods.” Read full story Source: National Nurses United, 11 February 2022
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News Article
"I’m dying" – Son shares desperate 999 calls
Patient Safety Learning posted a news article in News
Bina Patel, aged 56, died after struggling to breathe and waiting almost an hour for an ambulance. Her son Akshay Patel has shared the six phone calls he made to North West Ambulance Service on the night of her death. North West Ambulance say they "can never say sorry enough" for Bina's death. "The amount of time it took for help to arrive is unacceptable and not how we want to care for our patients," a spokesperson said. View video Source: BBC News, 26 January 2022 -
News Article
ICS told to increase help for trust that treated patients on the floor
Patient Safety Learning posted a news article in News
A troubled integrated care system has been told it must provide more help to a severely under-pressure acute trust where patients were treated on the floor and in a storeroom. The Care Quality Commission said Devon ICS must give more “input” to University Hospitals Plymouth Trust, where inspectors warned staff could “not ensure the safety of all patients” arriving at the emergency department. During a visit to the trust’s Derriford Hospital in September, inspectors saw staff treating six patients who “lay on the floor” of the ambulatory assessment unit, while another patient who had been in the department overnight was being “treated/assessed in the ‘storeroom’” – according to the CQC’s report. Inspectors reported: “The department was overcrowded, there was no seating available… Social distancing was not possible.” While the CQC praised senior leaders in the ED and executive chiefs for being “open to challenge” and “understanding the problems” faced by the urgent and emergency care service, inspectors said there was only so much the trust could do alone. Catherine Campbell, head of hospital inspection at CQC, said: “The impact of a high number of patients attending to receive care, combined with reduced staffing levels in the ED, created issues that the trust couldn’t solve alone and further support was needed from the local health and social care system." Read full story (paywalled) Source: HSJ, 19 January 2022 -
News Article
Doctors warn hospitals ‘not coping’ as study links A&E waits to deaths
Patient Safety Learning posted a news article in News
Hospitals are not able to cope with current pressures, senior doctors have warned, as a new study links long A&E waits to an increased risk of death. Patients waiting more than five hours within an emergency department are at an increased risk of dying, according to a study published in the Emergency Medicine Journal (EMJ). The study’s findings come as emergency care performance across England continues to deteriorate, and as pressures across hospitals mean that more patients are waiting for more than four hours in A&E departments than ever before. According to the research, death rates for patients waiting between six and eight hours before admission to hospital were 8% higher, and they were 10% higher for those waiting eight to 12 hours. The study was based on data collected prior to the pandemic, and national A&E waiting times have since deteriorated further. In November last year, the Royal College of Emergency Medicine (RCEM) warned that long delays and overcrowding in A&Es may have caused thousands of deaths during the pandemic. Researchers said that although cause and effect could not be established between longer waits and deaths after 30 days of hospital admission, they recognised a statistically significant trend. The paper said: “Long stays in the emergency department are associated with exit block and crowding, which can delay access to vital treatments. And they are associated with an increase in subsequent hospital length of stay, especially for older patients. Read full story Source: The Independent, 19 January 2022 -
News Article
‘Challenged’ trust plans to move patients to chairs to free up beds
Patient Safety Learning posted a news article in News
An acute trust in the Midlands is planning to move patients to chairs on wards to free up beds for people waiting in its emergency department, following one of its “most challenged” days. In an email sent to staff at Nottingham University Hospitals on Tuesday, interim chief operating officer Rachel Eddie and chief medical officer Keith Girling wrote: “We are asking wards to transfer [patients confirmed as ready for discharge] to the discharge lounge, or if that isn’t possible, move them to a chair on the ward so that a patient waiting for a bed in ED or in an emergency pathway assessment area can be brought up.” “This is referred to as going ‘one over’,” the email added. “We will ensure that on each ward that has been designated as being able to go ‘one over’, a chair has been added to their Nervecentre ward layout so patients are all visible.” The email describes how Monday was one of the “most challenged Mondays we have seen” and confirmed the trust remains in ‘Opel 4’, the most severe level of operational pressure. It also said nursing staff have “shared concerns” about the amount of time they are able to spend with their patients. “This does mean that at times you will be asked to work at a higher patient to nurse ratio than we would like,” the email said. “We know this isn’t where any of us want to be, but it is unfortunately the reality of balancing risk.” Read full story (paywalled) Source: HSJ, 1 December 2021 -
News Article
Mid and South Essex NHS Foundation Trust told it must improve
Patient Safety Learning posted a news article in News
Changes must be made across services at one of England's biggest NHS trusts following its first wide-ranging inspection, a health watchdog said. Mid and South Essex NHS Foundation Trust - which runs Basildon, Southend and Broomfield hospitals - has been rated as "requires improvement". The Care Quality Commission (CQC) turned up unannounced after concerns over standards were raised. Philippa Styles, the CQC's head of hospital inspection, said they "found a mixed picture" of positive improvements and areas of concern. "Following the trust's formation in 2020, leaders should now be able to work together effectively to ensure care is consistent across all services," she said. "I recognise the enormous pressure NHS services are under... and that usual expectations cannot always be maintained, especially in the urgent and emergency department, but it is important they do all they can to mitigate risks to patient safety." The report said: Patients had not always been protected from harm. Staff had not all received mandatory training. There had been nine "never-should-happen" medical events. Records were sometimes inaccurate and not kept securely. Nursing and medical staffing was a "challenge across the trust", with shifts regularly below planned staffing numbers. There had been a high number of whistle-blowers raising concerns. Read full story Source: BBC News, 1 December 2021 -
News Article
A&E overcrowding in UK ‘killing thousands a year’, say doctors
Patient Safety Learning posted a news article in News
Thousands of patients a year are dying because of overcrowding in A&E units in Britain, and more fatalities will follow this winter, emergency care doctors claim. An estimated 4,519 people in England died in 2020-21 as a direct result of people receiving less than ideal care while delayed in A&E waiting to start treatment in the hospital. “To say this figure is shocking is an understatement. Quite simply, crowding kills,” said Dr Adrian Boyle, a vice-president of the Royal College of Emergency Medicine (RCEM). There have also been 709 deaths in Wales and 303 in Scotland so far this year for the same reason, according to a report by the college. Another 566 excess deaths caused by overcrowding occurred in Northern Ireland in 2020-21. The 4,519 in England “may be an underestimate”, it adds. The four figures taken together mean the college has identified at least 6,097 deaths across the four home nations that it believes occurred because overcrowding hampered the person’s treatment. “There’s a lot of human misery behind these figures. It’s uncomfortable and unbearable that people are being put through this. It’s impossible not to feel upset and angry about this,” Boyle said. Read full story Source: The Guardian, 18 November 2021 -
News Article
East of England Ambulance Service warns of 999 call delays
Patient Safety Learning posted a news article in News
An NHS ambulance service boss has urged 999 callers to not hang up as "there may be a delay before we pick up". The East of England Ambulance Service (EEAS) said demands on the health service meant it was extremely busy. Marcus Bailey, EEAS chief operating officer, said delays were due to a "combination" of Covid, winter pressures and recruitment. He said the service planned to recruit 100 call-handlers over the next few months to help ease pressure. The EEAS has published posters online telling emergency callers to be patient. The service covers Bedfordshire, Cambridgeshire, Essex, Hertfordshire, Norfolk and Suffolk. Mr Bailey told BBC Look East: "It's about us warning people who are phoning 999 that it's really busy and at some points there may be a delay before we pick up the 999 call. "Remain on the line, don't hang up, and we will get to you as soon as possible." Read full story Source: BBC News, 9 November 2021 -
News ArticleInside the emergency department at Sparrow Hospital in Lansing, Michigan, staff members are struggling to care for patients showing up much sicker than they’ve ever seen. Tiffani Dusang, the ER’s nursing director, practically vibrates with pent-up anxiety, looking at patients lying on a long line of stretchers pushed up against the beige walls of the hospital hallways. “It’s hard to watch,” she said. But there’s nothing she can do. The ER’s 72 rooms are already filled. “I always feel very, very bad when I walk down the hallway and see that people are in pain, or needing to sleep, or needing quiet. But they have to be in the hallway with, as you can see, 10 or 15 people walking by every minute,” Dusang said. The scene is a stark contrast to where this US emergency department — and thousands of others — were at the start of the pandemic. Except for initial hot spots like New York City, in spring 2020 many ERs across the country were often eerily empty. Terrified of contracting covid-19, people who were sick with other things did their best to stay away from hospitals. Visits to emergency rooms dropped to half their typical levels, according to the Epic Health Research Network, and didn’t fully rebound until this summer. But now, they’re too full. Even in parts of the country where covid isn’t overwhelming the health system, patients are showing up to the ER sicker than before the pandemic, their diseases more advanced and in need of more complicated care. Read full story Source: Kaiser Health News, 29 October 2021
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News Article
'Major changes needed' at Northern Ireland emergency departments
Patient Safety Learning posted a news article in News
Major change is required if Northern Ireland's emergency departments are to avoid another "exceptionally difficult" winter, a senior consultant has warned. Dr Brendan Lavery, who works for the Western Health Trust, said "standing still is not an option". He described the system as currently operating on a "knife edge". The Department of Health said it was "a very challenging time" for staff "with COVID-19 restrictions impacting on an already fragile system". Speaking to BBC News NI, Dr Lavery likened the situation to "Groundhog Day" with decade-long problems like capacity and staffing exacerbated by the lingering effect of the COVID-19 pandemic on other healthcare services. The department responded: "Well before COVID-19, there was clear evidence that our urgent and emergency care services were under increasing pressure. This is an unsustainable position that requires sustained investment and reform, including, of course, long-term investment in staffing. There is no quick or easy solution to these problems." Read full story Source: BBC News, 12 May 2021 -
News Article
Hospital admits patient care is being compromised as cancer operations delayed
Patient Safety Learning posted a news article in News
Cancer operations at one of England’s largest hospital trusts are being delayed as bosses admit patient care on wards is being compromised. Nottingham University Hospitals Trust has been forced to convert one of its few remaining wards for cancer surgery patients into an emergency medical ward to cope with an influx of patients. The Independent understands the trust’s A&E department is regularly overcrowded with 40 or more patients waiting for a bed at the start of most days. In a leaked message to staff sent on Friday and shared with The Independent, bosses at the hospital said the trust was facing an “exceptionally difficult time” which was “probably the most challenging position we have been in since the pandemic began”. It added: “There is no doubt that we are having to compromise the quality of care we are providing to some patients to ensure that we are able to maintain a service for the whole population.” “Our emergency department is over capacity continuously, which means that patients are waiting for extended periods on trolleys with little privacy and dignity because they do not have a bed to go to. We are having to make difficult decisions every day as to whether we can proceed with cancer and urgent operations and we are not able to tell some patients when they will get their operation." Read full story Source: The Independent, 13 September 2021 -
News Article
Big surge in the most serious ambulance calls
Patient-Safety-Learning posted a news article in News
Performance data published by NHS England has revealed a big surge in the number of immediately life-threatening incidents ambulance services have responded to. The data also showed average response times have increased and a large number of patients are attending emergency departments. So far, the reason for the increase remains unclear, however, a potential factor could be the return of respiratory illnesses, particularly in children, as the lockdown has eased. In a statement Association of Ambulance Chief Executives said, ”The reasons for the demand increases are complex and will include some patients who have not accessed care as early as they might have done normally and therefore present to the ambulance service as a high acuity patient and many patients who are contacting us for lower acuity issues which in some cases could have been managed by accessing other parts of the UEC system. We continue to work closely with NHS England to mitigate the demand as much as possible and encourage sign-posting of patients to other parts of the UEC system when that is a safe and more appropriate solution to their problem.” Read full story (paywalled). Source: HSJ, 12 August 2021
